Healthcare Provider Details

I. General information

NPI: 1720387590
Provider Name (Legal Business Name): SPIRO KOTSIOS M.A., BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2011
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 BAHIA DEL MAR CIR APT 401
SAINT PETERSBURG FL
33715-2357
US

IV. Provider business mailing address

5701 BAHIA DEL MAR CIR APT 401
SAINT PETERSBURG FL
33715-2357
US

V. Phone/Fax

Practice location:
  • Phone: 727-278-1171
  • Fax:
Mailing address:
  • Phone: 727-278-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-18495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: